Vol. 72 August 1, 2012 Obamacare and the Olympics

The Olympics, like Presidential elections in the U.S., occur every four years. Cities, like candidates, compete fiercely and spend lots of money to be the winner of the “host” contest. No one really knows how much the hosting, or the Presidential term will cost, and no one is ever sure how it wil be paid for. Both always end up costing more than anticipated. The Olympic games, like our Presidential elections, often reflect the state of our world at the time.

The British opened their Olympic Games with a stupendous show that included a celebration of their National Heath Service! It must have been a Socialist conspiracy, something we would expect from China. Can you imagine that ever happening in America!? Medicare is almost as old as the NHS (born in 1965 rather than 1948), is a great comfort to those over 65, and politicians attack its benefits at their own peril, BUT a celebration of Medicare during the Super Bowl halftime? I don’t think so! Maybe in twenty years.

America does have the best medical care in the world for most people, but I think that we are so busy explaining why it is so expensive and why not everyone has access to it that we never get around to celebrating it. Now that the constitutional fight over ACA has been resolved by the Supreme Court maybe we can begin to celebrate some of its positive aspects.

The extension of coverage on family policies to children up to the age of 26 proved to be so popular that most insurance companies announced that they would provide that coverage even if the court struck down the act. Likewise, providing coverage for pre-existing conditions.

Whether the penalty for not obtaining insurance coverage is a tax or not is still a political football, but the tax (according to the Supreme Court) will amount to about $95 a year in 2014. 26 cents a day seems to be a ridiculously small price to pay for counting on other tax payers to cover your medical bills if you lose life or limb.

Micheal Phelps did not win his record-breaking gold medal in the solo medley event, but did so in the four man relay. His solo event fourth-place finish should remind us all that despite supreme conditioning, a dedicated will, and a stellar record, the body does age and performance decreases. We will all be eligible for Medicare some day. Why not sooner than later if current Medicare subscribers think it so great?. Phelp’s team win reaffirms how performance can improve with the help of trained colleagues. The ACA incentivizes the formation of “Medical Homes” of primary care physicians, nurse practitioners, physician assistants, social workers, and others organized together to deliver patient-centered care. We will need such organizations of physicians and physician extenders. A significant “unintended consequence” of the ACA, now just being discussed, will be the shortage of primary care physicians to provide the care for the newly insured under ACA.

What about that 5 foot weight-lifter 123 pound that no one ever heard of stepping up and lifting over three times his own weight?! Not much has been said about the Center for Effectiveness Research established by the ACA. It is no five-footer, but is one of those “sleepers” in the Act that could profoundly effect our health care by system by evaluating and publicising the benefits ( and costs) of new technology. Another “small item” in the ACA which may eventually become perceived as a giant is insurance coverage for mental health services, a first.

The Queen’s granddaughter’s equine competition has at least knocked the stories about Romney’s Dressage horse off the TV. Maybe Obama’s grandchildren will compete in a future Olympics (women’s basketball?). Better yet, the opening show, like this year’s scene of the Queen greeting Mr. Bond, could feature the then-President turning in his chair and greeting his visitor with, “Welcome back, Dr. Berwick”.

By then we may know if Olympic athletes are genetically superior to us mere mortals. I am sure that we will be screening them for “gene therapy”. As Dr. David Jones states in his NEJM article on the medical history of the Olympics, “What’s the limit of human performance? We still don’t know”.

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One Response to Vol. 72 August 1, 2012 Obamacare and the Olympics

The NHS in England is certainly something to celebrate. After WWII England was economically devastated and had huge numbers of soldiers with war injuries. As a country they decided to create the NHS to give everybody some degree of health care “free at the point of service”. What a success. The UK now delivers better care than the US at about half the cost. In the past 5 years modernization efforts have improved the infrastructure and reduced the infamous waiting times. They don’t have a physician shortage because they control the training programs to train the doctors they need. They don’t argue about physician salary since doctors all have the same base salary (plus or minus incentives based on quality). The NICE program is very successful in evaluating drugs and devices — for COST effectiveness rather than effectiveness. The French probably have the best health care in the world. The quality of US healthcare is way down the list — not quite as good as Costa Rica! The US would not be winning any gold metals for health care.